BVA9510140
DOCKET NO. 93-16 405 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in Waco, Texas
THE ISSUES
1. Entitlement to service connection for a disability
manifested by right side pain.
2. Entitlement to service connection for migraine headaches.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of
the United States
ATTORNEY FOR THE BOARD
James A. Frost, Associate Counsel
REMAND
The veteran served on active duty from January 1986 to May
1992.
This appeal arose from rating decisions in June 1992 and
March 1993 by the Department of Veterans Affairs (VA)
Regional Office (RO) in Waco, Texas.
In her substantive appeal, received at the RO in June 1993,
the veteran stated her belief that right side pain, for which
no definitive diagnosis has been made, may be related to her
service in the Southwest Asia Theater of Operations during
the Persian Gulf war. VA has recently promulgated a final
rule concerning compensation for certain undiagnosed
illnesses of Persian Gulf war veterans. 60 Fed. Reg. 6665
(1995) (to be codified at 38 C.F.R. § 3.317). The Board of
Veterans' Appeals (Board) construes the veteran's statement
as a claim for such compensation, and that claim is referred
to the RO for appropriate consideration.
With reference to the veteran's claim of entitlement to
service connection for a disability manifested by right side
pain, the record reveals that various diagnoses have been
entertained by physicians over the years in response to her
complaints. During her period of active service, in April
1991 the assessment was gastroenteritis/urinary tract
infection. In July 1991 she was seen for pelvic pain of
unknown etiology; the assessment was possible endometriosis
or ovarian cyst; a laparotomy was negative; the diagnosis was
unexplained pelvic pain. A pelvic ultrasound showed a
slightly retroverted uterus. An obstetrical-gynecological
examiner's impression was possible pelvic endometriosis or
pelvic pain of unknown cause. In August 1991 at a physical
therapy clinic the assessment was a probable trigger point of
the right external oblique muscle.
In December 1991 the veteran continued to complain of right
lower quadrant abdominal pain with radiation to the anterior
right thigh. X-rays of the pelvis and hips were negative.
At an examination for service separation in February 1992 it
was noted that the veteran had chronic right lower quadrant
pain, for which a diagnosis was not made. At an orthopedic
clinic in late February 1992 a bone scan was negative; the
assessment was inguinal pain of unknown etiology, not
orthopedic-related.
The veteran was seen at a service department hospital in
April 1992; the impression was chronic pelvic pain secondary
to pelvic congestion. After her separation from service she
was seen at the service department hospital in August 1992,
when endometriosis and right sciatica were suspected. In
September 1992 at an obstetrical/gynecological clinic
impressions included possible endometriosis and rule out
conversion disorder. In October 1992 at a physical medicine
and rehabilitation clinic lateral femoral cutaneous
neuropathy, or meralgia paresthetica, was suspected.
Upon consideration of the history of the veteran's complaints
about right side pain, set forth above, the Board believes
that an attempt should be made to determine medically which
disease(s) or injury may account for any current
symptomatology and the etiology of any such disorder.
Accordingly, this case is REMANDED to the RO for the
following:
1. The RO should verify the veteran's
current residence address, that is,
whether she continues to reside in
Germany, as she reported to VA in
November 1994, or whether she has
returned to the United States.
2. The RO should request that the
veteran identify each physician or
medical facility, VA or non-VA, which has
treated her for right side pain,
including pain in the abdomen and right
lower extremity, since January 1993. The
RO should attempt to obtain copies of all
such clinical records.
3. The RO should make arrangements for
the veteran to undergo medical,
gynecological, orthopedic and
neuropsychiatric examinations. It is
imperative that the examiners be made
aware of the veteran's medical history as
set forth above in this REMAND. The
examiners should attempt to arrive at a
diagnosis of the disorder, if any, of
which the veteran's complaint of right
side pain is a sign or symptom. If such
a disorder is diagnosed, the examiners
should offer opinions as to its etiology
and time of onset.
4. Following completion of these
actions, the RO should review the
evidence and determine whether the
veteran's claim of entitlement to service
connection for a disability manifested by
right side pain may now be granted. In
the event that service connection for
such a disability is denied, the RO
should adjudicate the veteran's claim
under the provisions of 38 C.F.R.
§ 3.317. If the decision is adverse to
the veteran, she and her representative
should be provided with an appropriate
supplemental statement of the case and an
opportunity to respond thereto. The case
should then be returned to the Board for
further appellate consideration.
The purposes of this REMAND are to obtain clarifying medical
information and to provide the veteran with due process of
law. By this REMAND the Board intimates no opinion, legal or
factual, as to the ultimate disposition of the appeal.
Appellate review of the issue of entitlement to service
connection for migraine headaches is deferred, pending
completion of this REMAND. No action is required of the
veteran until she receives further notice.
ALBERT D. TUTERA
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. § 20.1100(b)
(1994).